My friend Carrie is a 40-year-old woman who had her yearly physical a few months ago and was informed that she has high cholesterol and is overweight. Read
Last month, the federal government announced it would provide a $33 million grant to help underwrite a clinical trial to develop a pharmaceutical approach to preventing Alzheimer’s disease.
This news comes on the heels of a report that the latest candidate in the pipeline of drugs designed to treat Alzheimer’s disease had failed, miserably. In fact, the drug, semgacestat, actually hastened the cognitive decline of people who received it, according to research published in The New England Journal of Medicine.
While the idea of creating a drug to prevent Alzheimer's seems honorable, it’s important to consider that the development of such a drug means big business beyond measure. Deutsche Bank estimates that the development of an efficacious drug treatment for the disease once it has taken hold could generate $20 billion in annual sales. But the value of a drug employed to treat people before there is any evidence of dementia—a far larger treatment group compared to those already afflicted—would be staggering.
New York Times writer Pam Belluck reported that the goal of this grant would be to develop a preventive treatment using a strategy much like the one for heart disease. Belluck quoted Laurie Ryan, program director for the Alzheimer’s clinical trials at the National Institute on Aging, who said, “We’re going to look at people at risk, just like we do with people who have high cholesterol and are at risk for cardiovascular disease.”
For now, let's ignore the comparisons with cholesterol, which is a fundamental component in the protection of brain cells, and let's focus on the attempt to develop an Alzheimer’s prevention pill. What's ironic is the fact that well-respected neuroscience research clearly defines the powerful role of modifiable lifestyle factors in dramatically reducing the risk for this disease—a disease now costing Americans some $200 billion annually. That's almost triple what we spend on treating patients with heart disease, according to a recent RAND report published in the New England Journal of Medicine.
What's so desperately challenging is the recognition that the science supporting the powerful relationship between lifestyle choices and risk for Alzheimer’s, an incurable condition, is all but ignored. After all, these lifestyle choices cannot be monetized. They cannot be manipulated in the quest for the brass ring.
As a practicing neurologist specializing in neurodegenerative conditions, I’m face to face with the devastation not just of the individual, but of the families and friends of Alzheimer’s patients every day. And while the RAND report quantifies the monetary expense of this condition, there is no metric for the emotional impact on those who must helplessly observe the merciless progressive cognitive decline in someone they love.
Beyond their grief lies a fear in the children of Alzheimer’s patients that no doubt will play into the hands of those involved in developing the prevention drug. This fear is so often confided to me after I’ve evaluated a patient when a son or daughter pulls me aside and asks what they can be doing so that they don’t “end up like dad.” This is often followed by a statement like, “This is so tough. You just can’t imagine what it’s like.”
It’s then that I explain that in fact there’s a lot that they can do to meaningfully impact their risk for Alzheimer’s disease and it’s not in the form of anything purveyed on a prescription pad.
I discuss the work of Dr. Deborah Barnes, a dedicated Alzheimer’s researcher at the University of California San Francisco whose report in the prestigious journal Lancet Neurology demonstrated that specific modifiable lifestyle factors like physical inactivity, diabetes, and smoking are associated with an astounding 54% of Alzheimer’s cases in the United States (2.9 million patients).
I provide them with copies of a 2012 Mayo Clinic report published in the Journal of Alzheimer’s Disease showing that adults eating mostly carbohydrate rich foods ended up with an 89% increased risk of becoming demented, while those whose diets had higher levels of healthful fat actually experienced a 44% risk reduction for dementia.
I show them the report from last month published in the New England Journal of Medicine demonstrating how even mild elevations of blood sugar, well below the range that would qualify for the diagnosis of full-blown diabetes, levels that wouldn't concern many doctors, are actually associated with a dramatic increased chance for developing dementia.
My other option is to somehow convince myself to convey a sense of hope that medical research might develop a pharmaceutical intervention sometime in the next decade or two to help reduce everyone's risk for becoming mentally compromised. However, understanding that the tools for Alzheimer’s prevention are already at hand makes this option untenable.
As for their other comment, the one about not knowing what it’s like to deal with this disease affecting someone you love, I often cross the line in terms of relating personal experience during what is considered a professional encounter. I'll often explain that each morning before I see patients in our clinic, I visit with a brilliant neurosurgeon.
By the time I arrive at his assisted living facility he’s fully dressed in preparation for making rounds in the hospital, visiting his patients to make sure they were comfortable through the night. The truth is he hasn’t practiced medicine for almost 30 years. My hope each morning is that my dad might remember my name.
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